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MICROBIOLOGY - PARASITOLOGY - IMMUNOLOGY - VIROLOGY
MPIV STAT (may incur additional charges) Previous Case # ______________
VETERINARY DIAGNOSTIC LABORATORY University of Illinois at Urbana-Champaign PO Box U, 2001 South Lincoln Avenue Urbana, IL 61802-6178 Tel: (217) 333-1620 Fax: (217) 244-2439
Email: [email protected] Website: vetmed.illinois.edu/vdl
F SYS-68 August 2016 Page 1 of 2
VETERINARIAN RESULTS FAX EMAIL CLINIC EMAIL VET ONLINE/APP
CLINIC/HOSPITAL COPY RESULTS VTH OTHER (NAME WITH FAX OR EMAIL BELOW) ADDRESS _________________________________________________________________________
SEND SUBMISSION FORMS FEE SCHEDULE CITY STATE ZIP OWNER NAME PHONE ( ) FAX ( ) CITY STATE ZIP CLINIC EMAIL BREED AGE VET EMAIL SPECIES CANINE FELINE EQUINE BOVINE PORCINE
OVINE CAPRINE AVIAN OTHER P.O./ACCT #/FOP FEIN # NEW CLIENT UPDATES SEX M F MC FS WEIGHT BILLING COMMENTS (Owner billing not available) ANIMAL ID MORE ID’S ON BACK
DATE SENT / /
USPS UPS FEDEX COURIER DROP OFF OTHER
CONDITIONS SUSPECTED (HISTORY ON PAGE 2) DATE COLLECTED / /
SPECIMEN TISSUE FECES WHOLE BLD . SERUM URINE SWAB SITE_________
*ADDITIONAL TESTING MAY BE AVAILABLE, CHECK OUR WEBSITE FOR DETAILS* MICROBIOLOGY PARASITOLOGY IMMUNOLOGY
MICROBIOLOGY
CULTURES
Aerobic culture Aerobic culture & 1 Susceptibility Aerobic culture & up to 2 Susceptibility Aerobic culture & up to 4 Susceptibility Anaerobic culture Biolog Microphenotypic ID (3 replicates) Brucella culture Campylobacter culture Environmental/C & D MALDI-TOF-identification MALDI-TOF-Heirachical Cluster Analysis Mastitis evaluation/culture Milk bulk tank culture (qualitative & quantitative) Mycobacterium culture (rapid growing) Mycology (fungal) culture Rapid urea – Helicobacter screen Salmonella- See "Salmonella PCR" Shigella culture Subculture (banking and slants for transport) Yersinia culture SUSCEPTIBILITY TESTING
Aerobic Susceptibility (additional at full price) Anaerobic isolates Extended G+/G- panels Individual E-test MIC strip ______________ Individual K-B Disk __________________ Methicillin MIC Mycobacterium/Nocardia panel Ophthalmic KB Panel (Topical) Yeast MIC – 9 drug panel MOLECULAR DETECTION OR CHARACTERIZATION
16S-23S rRNA (bacterial sequence id) 5S -18S rRNA (mycology sequence id) Blastomyces dermatitidis PCR Brachyspira PCR Brucella PCR Campylobacter species PCR
MOLECULAR DETECTION OR CHARACTERIZATION
Clostridium difficile toxin ELISA Clostridium FA Blackleg Clostridium perfringens toxin typing PCR E. coli virulence PCR (adhesins & toxins) Francisella tularensis PCR Lawsonia rPCR Leptospira urine/tissue rPCR ONLY Leptospira Panel (incl PCR & Titer Profile) Leptospira Serum Titer Profile ONLY (includes
autumnalis, bratislava, canicola, grippotyphosa, hardjo, ictero-haemorrhagiae, pomona)
Listeria monocytogenes PCR Mycobacterial PCR (slow growing) M. Paratuberculosis PCR [Johne’s] Mycoplasma PCR [hematogenous] (by host species) Mycoplasma PCR - respiratory, joint, milk Mycoplasma speciation (16S sequencing) Ophidiomyces PCR P. destructans (White Nose) PCR Potomac Horse fever PCR Rhodococcus equi rPCR Salmonella PCR (positive includes culture/ isolation) 1 sample/1 submission 3 successive tests/1 submission Strep equi M-protein PCR (includes culture) Strep equi typing – szp and sem sequencing Tick borne Pathogen PCR Panel- (Includes all
tests below)Or select one or more Anaplasma PCR Babesia PCR Bartonella PCR Borrelia PCR Ehrlichia PCR Rickettsia PCR
Recent Antimicrobial Therapy _____________________________________________________________________________________________________________________ URINE COLLECTION METHOD__________________
SPECIALIZED STAIN/MICROSCOPIC EXAMINATION
Acid fast stain – (Mycobacteria, Nocardia) Gram stain examination Lacto phenol cotton blue (fungal stain) VB4R (spirochetes)
PARASITOLOGY
Baermann technique Cryptosporidium acid-fast stain Fecal flotation (double sugar
centrifugation) Giardia (ZnSO4 double centrifugation) Microfilaria (Knott’s) Parasite identification (Ecto/Endo
parasites) Fecal egg count
IMMUNOLOGY/SEROLOGY.
Antinuclear antibody (ANA) Brucella canis IFA Johne’s ELISA (Bovine, Caprine, Ovine) Mycoplasma hyopneumoniae ELISA
(Porcine) Neospora ELISA (Bovine) Neospora IFA (Canine) Toxoplasma (IFA) IgM Screen IgG Screen IgG Titer
HEARTWORM TESTS Canine Snap®4DX + heartworm panel
(includes: E. canis, Lyme disease, A. phagocytophilum, A. platys and Dirofilaia immitis) (performed by CP)
Feline heartworm Ab (performed by CP)
AUTHORIZED SIGNATURE (OPTIONAL) ______________ REC’D BY (INITIALS)
AC
CESSIO
N # _ _Place sticker here_
MICROBIOLOGY • PARASITOLOGY • IMMUNOLOGY • VIROLOGY (PAGE 2)
F SYS-68 August 2016 Page 2 of 2
VIROLOGY
EM NEGATIVE STAINING (FS-MRL)
feces tissue
ROTAVIRUS ANTIGEN ASSAY
feces intestine
VIRUS ISOLATION
Virus suspected_______________
Avian MOLECULAR
APMV (New Castle Disease) (rRT-PCR) Matrix (rRT-PCR) (all APMV types) vNDV (rRT-PCR) (virulent APMV) Influenza A virus (rRT-PCR)
Canine MOLECULAR
Influenza A virus (rRT-PCR) FLUORESCENT ANTIBODY (FA)
Canine adenovirus types 1 & 2 Canine coronavirus Canine distemper virus Canine herpesvirus Canine parainfluenza virus type 2 Canine parvovirus
Equine SEROLOGY
Equine herpesvirus 1 & 4 (SN) Equine infectious anemia virus
(ELISA) (Only Federal or Illinois Form Required)
Equine arteritis virus (SN)
MOLECULAR
Equine respiratory viruses Panel - all four below (does not include
EHV1 Pathotyping) Influenza A Virus (rRT-PCR) EHV4 (rPCR) EAV (rRT-PCR) EHV1 (rPCR) EHV1 Typing (wild type vs EHM virulent)
(rPCR) FLUORESCENT ANTIBODY (FA)
Equine adenovirus Equine herpesvirus type 1 & 4
Feline SEROLOGY
Feline calicivirus (SN) Feline herpesvirus (SN) Feline immunodeficiency virus
(FIV) (ELISA-Ab)
Feline (continued) SEROLOGY (CONTINUED)
Feline infectious peritonitis virus (FIP) (IFA) Antibody SCREEN (1:6400) Antibody TITER (1:400 to 1:6400) Feline leukemia virus (FLV) (ELISA-Ag) Feline Profile I (FIP scrn, FeLV, FIV, Toxo) Feline Profile II (FIP screen, FeLV) FLUORESCENT ANTIBODY (FA)
Feline herpesvirus Feline infectious peritonitis virus (FIPV,FCoV) Feline panleukopenia virus (FPV, parvovirus)
Porcine SEROLOGY
Encephalomyocarditis virus (EMCV) (SN) PRRS antibody screen (ELISA) IFA if ELISA positive PRRSV antibody screen, US strain PRRSV antibody screen, EU strain PRRSV antibody titer, US strain PRRSV antibody titer, EU strain Porcine transmissible gastroenteritis virus
(TGE) (SN)
MOLECULAR
Influenza A virus (rRT-PCR) Porcine circovirus type 2 (rPCR) PRRSV (rRT-PCR multiplex – differentiates NA vs. EU) oral fluids (OF) serum, individual samples serum, pooled samples groups of _______ tissue, individual samples tissue, pooled samples groups of _______ SECD Panel (All three below ) (rRT-PCR) PDCoV (rRT-PCR) PEDV (rRT-PCR) TGEV (rRT-PCR)
SEQUENCING
PRRSV ORF5 with alignment PRRSV ORF5 sequence alignment from case
to previous case(s) #:
FLUORESCENT ANTIBODY (FA)
Porcine adenovirus Porcine circovirus (PCV2) Porcine hemagglutinating encephalomyelitis Porcine parvovirus Porcine rotavirus Porcine coronavirus PRCV TGEV
Porcine (continued) FLUORESCENT ANTIBODY (FA) (CONTINUED)
Pseudorabies virus (PrV) Swine influenza virus (SIV)
Ruminant SEROLOGY
Bluetongue virus (ELISA) Bovine herpesvirus type 1 (IBR) (SN) Screen [1:4 to 1:256] Endpoint titer [1:4 to 1:65,536] Bovine leukosis virus (ELISA) Bovine parainfluenza virus (PI3) (SN) Bovine viral diarrhea virus (BVD) Type 1 (SN): Screen [1:4 to 1:256] Endpoint titer [1:4 to 1:65,536] Type 2 (SN): Screen [1:4 to 1:256] Endpoint titer [1:4 to 1:65,536] Bovine viral diarrhea virus PI screen (VI-ICC) Caprine arthritis encephalitis virus (ELISA) Epizootic hemorrhagic disease virus (AGID) Ovine progressive pneumonia virus (ELISA)
MOLECULAR
Bluetongue virus/EHDV (rRT-PCR multiplex) Bovine coronavirus (rRt-PCR) Bovine viral diarrhea virus type 1 & 2 (rRT-PCR
multiplex - differentiates) whole blood - acute whole blood - PI (< 3 months of age) serum – PI (> 3 months of age) tissue Bovine Respiratory Disease Panel (All three below) (BRD) IBR PI3 BRSV FLUORESCENT ANTIBODY (FA)
Bluetongue virus Bovine adenovirus Specify type: 1 3 5 Bovine coronavirus Bovine herpesvirus type 1 (IBR) Bovine herpesvirus type 2 Bovine herpesvirus type 4 Bovine papular stomatitis virus Bovine parainfluenza virus type 3 Bovine parvovirus Bovine pseudocowpox virus Bovine reovirus Bovine respiratory syncytial virus Bovine rotavirus Bovine viral diarrhea virus types 1 & 2 Epizootic hemorrhagic disease virus Orf/Ovine (contagious pustular dermatitis)
HISTORY OR ADDITIONAL INFORMATION (INCLUDE ANTIMICROBIAL THERAPY):
OTHER TESTS:
TOTAL NUMBER OF SAMPLES MULTIPLE SPECIMEN IDENTIFICATION Attach Additional Sheets as Necessary
No. Specimen (Type, Tissue and ID) Sex Age No. Specimen (Type, Tissue and ID) Sex Age 1 11 2 12 3 13 4 14 5 15 6 16 7 17 8 18 9 19
10 20
ACCESSION # Place sticker here .
